Cross-country discrepancies on public understanding of stress concepts: evidence for stress-management psychoeducational programs.

BACKGROUND: Negative effects of stress have pose one of the major threats to the health and economic well being of individuals independently of age and cultural background. Nevertheless, the term "stress" has been globally used unlinked from scientificevidence-based meaning. The discrepancies between scientific and public stress knowledge are focus of concern and little is know about it. This is relevant since misconceptions about stress may influence the effects of stress-management psychoeducational programs and the development of best practices for interventions. The study aimed to analyze stress knowledge among the Canadian and Brazilian general public and to determine the extent to which scientific and popular views of stress differ between those countries. METHODS: We evaluated 1156 healthy participants between 18 and 88 years of age recruited from Canada (n = 502) and Brazil (n = 654). To assess stress knowledge, a questionnaire composed of questions regarding stress concepts ("stress is bad" versus "stress-free life is good") and factors capable of triggering the stress response ("novelty, unpredictability, low sense of control and social evaluative threat versus "time pressure,work overload, conflict, unbalance and children") was used. RESULTS: Both Canadian and Brazilian participants showed misconceptions about stress and the factors capable of triggering a stress response. However, the rate of misconceptions was higher in Brazil than in Canada (p < 0.05). CONCLUSION: These findings suggest a lack of public understanding of stress science and its variance according to a country's society. Psychoeducational programs and vulnerability of stress-related disorder are discussed.

Apathy is not associated with performance in brief executive tests in patients with mild cognitive impairment and mild Alzheimer's disease.

Neuropsychological correlates of apathy in Alzheimer's disease (AD) may shed some light on the neurobiology of this behavioral disorder. Whereas previous research has suggested an association between apathy and executive functions in AD, amnestic mild cognitive impairment (aMCI) cohorts point to an association with memory tests. We aimed to further investigate this issue in a sample of low educated, hitherto unexposed to cholinesterase inhibitors, aMCI (n=26) and mild AD (n=28) patients using brief executive tests, namely the Executive Interview (EXIT-25) and the Frontal Assessment Battery (FAB). Patients and controls (n=33) were included from a community-based survey of successful brain aging in Brazilian elderly (75+ years), The Pietà Study. The participants were submitted to a comprehensively neuropsychological assessment and apathy evaluation through the Apathy Scale (AS).We found a strong correlation in AD group between AS scores and functional performance measured by the Disability Assessment in Dementia (rho =-0.7 ; p<0,001). No association was found between any executive test performance and apathy symptoms. Apathy symptoms were also associated with the performance in memory tests and in the attention subscale of the Mattis Dementia Rating Scale. These findings reinforce the functional effect of apathy even in the mildest stages along the AD cognitive impairment spectrum, and challenges previous assumptions regarding the association between apathy and classical executive functions.

Serum levels of soluble TNF-a receptors but not BDNF are associated with apathy symptoms in mild Alzheimer's disease and amnestic mild cognitive impairment / Níveis Séricos de receptores Solúveis Do TNF-a mas não de BDNF estão associados a sintomas de apatia na doença de Alzheimer leve e no comprometimento cognitivo leve amnéstico

Apathy is intimately associated with dementia. Unfortunately, its pathophysiology remains poorly understood. The motivational impairment that characterizes this disorder might share the same inflammatory mechanisms, as suggested by the sickness behavior theory. OBJECTIVE: The primary aim of this study was to investigate the association between apathy symptoms and serum levels of tumor necrosis factor alpha (TNF-a) and its soluble receptors. Brain-derived neurotrophic factor (BDNF) levels were also analyzed since these have been associated with depression, a condition which shares abulic features with apathy. METHODS: The sample consisted of 27 subjects with mild Alzheimer's disease or amnestic mild cognitive impairment, who were submitted to specific apathy evaluation using the Apathy Scale (AS) and provided blood samples for biomarker analysis. Participants were categorized into two groups according to median AS scores (17 points). RESULTS: Subjects with higher apathy symptoms (n=13) displayed higher levels of TNF-a soluble receptors (type 1: p=0.03; type 2: p=0.04). No other difference was found between groups. CONCLUSION: These findings point to the involvement of inflammatory mediators in the genesis of apathy symptoms, as suggested by the sickness behavior theory.

Apatia está intimamente associada à demência. Lamentavelmente, sua fisiopatologia ainda é pouco compreendida. O comprometimento motivacional que caracteriza este transtorno poderia compartilhar mecanismos inflamatórios como sugere a teoria do comportamento associado à doença. OBJETIVO: O principal objetivo deste estudo foi investigar a associação entre apatia e os níveis séricos do fator de necrose tumoral alfa (TNF-a) e de seus receptores solúveis. Os níveis de fator neurotrófico derivado do cérebro também foram analisados já que estes foram associados à depressão, que compartilha aspectos abúlicos com a apatia. MÉTODOS: A amostra consistiu de 27 indivíduos com doença de Alzheimer leve ou com comprometimento cognitivo leve amnéstico, que foram submetidos à avaliação de apatia pela Escala de Apatia (EA), e proveram amostra de sangue para análise de biomarcadores. De acordo com a mediana de escores na EA (17 pontos), a amostra foi divida em dois grupos. RESULTADOS: O grupo com mais sintomas de apatia apresentou maiores níveis séricos de receptores solúveis de TNF-a (tipo 1: p=0,03 ; tipo 2: p=0,04). Nenhuma outra diferença foi encontrada entre os grupos.CONCLUSÃO: Estes achados sugerem o envolvimento de mediadores inflamatórios na gênese de sintomas de apatia, assim como sugere a teoria do comportamento associado à doença.

Serum levels of soluble TNF-α receptors but not BDNF are associated with apathy symptoms in mild Alzheimer's disease and amnestic mild cognitive impairment.

Apathy is intimately associated with dementia. Unfortunately, its pathophysiology remains poorly understood. The motivational impairment that characterizes this disorder might share the same inflammatory mechanisms, as suggested by the sickness behavior theory. OBJECTIVE: The primary aim of this study was to investigate the association between apathy symptoms and serum levels of tumor necrosis factor alpha (TNF-α) and its soluble receptors. Brain-derived neurotrophic factor (BDNF) levels were also analyzed since these have been associated with depression, a condition which shares abulic features with apathy. METHODS: The sample consisted of 27 subjects with mild Alzheimer's disease or amnestic mild cognitive impairment, who were submitted to specific apathy evaluation using the Apathy Scale (AS) and provided blood samples for biomarker analysis. Participants were categorized into two groups according to median AS scores (17 points). RESULTS: Subjects with higher apathy symptoms (n=13) displayed higher levels of TNF-α soluble receptors (type 1: p=0.03; type 2: p=0.04). No other difference was found between groups. CONCLUSION: These findings point to the involvement of inflammatory mediators in the genesis of apathy symptoms, as suggested by the sickness behavior theory.

Apatia está intimamente associada à demência. Lamentavelmente, sua fisiopatologia ainda é pouco compreendida. O comprometimento motivacional que caracteriza este transtorno poderia compartilhar mecanismos inflamatórios como sugere a teoria do comportamento associado à doença. OBJETIVO: O principal objetivo deste estudo foi investigar a associação entre apatia e os níveis séricos do fator de necrose tumoral alfa (TNF-α) e de seus receptores solúveis. Os níveis de fator neurotrófico derivado do cérebro também foram analisados já que estes foram associados à depressão, que compartilha aspectos abúlicos com a apatia. MÉTODOS: A amostra consistiu de 27 indivíduos com doença de Alzheimer leve ou com comprometimento cognitivo leve amnéstico, que foram submetidos à avaliação de apatia pela Escala de Apatia (EA), e proveram amostra de sangue para análise de biomarcadores. De acordo com a mediana de escores na EA (17 pontos), a amostra foi divida em dois grupos. RESULTADOS: O grupo com mais sintomas de apatia apresentou maiores níveis séricos de receptores solúveis de TNF-α (tipo 1: p=0,03 ; tipo 2: p=0,04). Nenhuma outra diferença foi encontrada entre os grupos. CONCLUSÃO: Estes achados sugerem o envolvimento de mediadores inflamatórios na gênese de sintomas de apatia, assim como sugere a teoria do comportamento associado à doença.

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly.

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly / Efeitos positivos de um programa de intervenção cognitivo-comportamental para cuidadores familiares de idosos com demência

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

OBJETIVO: Foi analisar os efeitos de um programa de intervenção de Terapia Cognitivo-Comportamental (TCC) administrado a cuidadores familiares de pacientes com demência. MÉTODOS: Foram incluídos 40 cuidadores familiares que participaram do programa durante oito sessões semanais. Foi avaliado o perfil cognitivo, funcional e comportamental dos pacientes, bem como sua qualidade de vida e de seus cuidadores familiares. Foram utilizados instrumentos específicos para a avaliação do nível de estresse do cuidador, estilos de enfrentamento (coping), ansiedade e depressão. RESULTADOS: Ao final do programa, os cuidadores familiares relataram diminuição dos sintomas neuropsiquiátricos nos pacientes e aumento da qualidade de vida deles. Observou-se ainda mudança no estilo de coping dos cuidadores e diminuição significativa do nível de ansiedade. CONCLUSÃO: O Programa de TCC mostrou-se instrumento útil e promissor para a prática clínica, revelando efeitos positivos na qualidade de vida e nos sintomas neuropsiquiátricos da demência, bem como promovendo alívio da ansiedade e do estresse dos cuidadores familiares.

Brazilian caregiver version of the Apathy Scale / Versão brasileira direcionada ao cuidador da Escala de Apatia

Abstract: No Brazilian version of a specific scale for evaluating apathy in dementia is available. Objectives: To introduce a translated version of the Apathy Scale (AS) for use with caregivers. Methods: The instrument was formally translated and then administered to the caregivers of a small sample of dementia patients, in order to assess scale comprehensibility and make final adjustments. The scale was subsequently administered to the caregivers of a second, independent sample of Alzheimer's disease (AD) patients. The content validity of the scale was tested by correlating the AS scores with the Neuropsychiatric Inventory (NPI) - apathy sub-score and Disability Assessment in Dementia (DAD) total scores. Results: The first sample consisted of eleven subjects with dementia, most of whom had AD. The second sample comprised twenty patients with probable or possible AD (10 with mild dementia), a mean age of 84.1±5.8 years, and 2.2±1.6 years of schooling. The AS scores correlated with both NPI-apathy sub-score (r=0.756, p=0.001) and DAD total scores (r=?0.793, p=0.0005). Conclusions: The final version had good comprehensibility and correlated strongly with standardized apathy and functional activities of daily living measures.

Resumo: Não há versão brasileira de qualquer escala especificamente dedicada à avaliação de apatia nas demências. Objetivos: Apresentar uma versão traduzida da Escala de Apatia direcionada ao cuidador. Métodos: O instrumento foi formalmente traduzido e administrado aos cuidadores de uma pequena amostra de pacientes com demência, para avaliar a compreensibilidade da versão e realizar ajustes finais. Em seguida a escala foi administrada aos cuidadores de uma segunda amostra independente de pacientes com doença de Alzheimer (DA). A validade de conteúdo da escala foi testada correlacionando-se os escores da Escala de Apatia com os subescores de apatia do Inventário Neuropsiquiátrico (NPI) e com os escores totais da escala DAD de incapacidade na demência. Resultados: A primeira amostra consistia de onze pacientes com demência, a maioria com doença de Alzheimer (DA). A segunda amostra possuía vinte pacientes com DA provável ou possível (10 com demência leve), média de idade de 84,1±5,8 anos e escolaridade média de 2,2±1,6 anos. Os escores na Escala de Apatia correlacionaram-se com o subescore apatia do NPI (r=0,756; p=0,001) e com os escores totais da DAD (r=?0,793; p=0,0005). Conclusões: A versão final apresentou boa compreensibilidade e correlacionou-se fortemente com medidas padronizadas de apatia e atividades de vida diária.

Sobrecarga do cuidador em demência em uma amostra Brasileira: associação com sintomas neuropsiquiátricos / Dementia caregiver burden in a Brazilian sample: Association to neuropsychiatric symptoms

Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce. Objective: To investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia. Methods: The Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson's correlations were calculated to measure the level of association between the scores on both instruments. Results: Among the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients' NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000). Conclusion: The presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.

Cuidar de idosos com demência, especialmente se eles apresentam transtornos de comportamento, pode ser extremantente exaustivo para os familiares e cuidadores. Geralmente, ocorrem mudanças no estilo de vida da família, e o cuidador precisa lidar com grande diversidade de problemas. Informações sobre este tema na América Latina, incluindo o Brasil, ainda permanece escasso. Objetivo: Investigar a relação entre a presença de sintomas neuropsiquiátricos e o nível de sobrecarga do cuidador em um grupo de idosos brasileiros com demência. Métodos: As versões brasileiras do Inventário de Sobrecarga de Zarit (ISZ) e do Inventário Neuropsiquiátrico (INP) foram administrados a um total de 83 cuidadores-familiares de pacientes com demência acompanhados em um ambulatório universitário. A correlação de Pearson foi calculada para medir o nível de associação entre os escores em ambos os instrumentos. Resultados: Entre os cuidadores, 83,1% eram mulheres, com idade média de 55,6±12,8 anos. Os escores do ISZ variaram entre 3 a 79 (média=31,4). Os escores do INP dos pacientes alcaçaram escores entre 0 a 102 (média=26,9), compatível com elevado grau de manifestações comportamentais na maioria dos pacientes. Uma correlação positiva significativa foi encontrada entre os escores obtidos no ISZ e o INP (r=0,402; p=0,000). Conclusão: A presença e a gravidade das manifestações comportamentais avaliadas pelo INP estão associadas ao alto nível de sobrecarga do cuidador nesta amostra de idosos brasileiros com demência.

Normative data for healthy elderly on the phonemic verbal fluency task - FAS.

Phonemic verbal fluency tests assess the production of words beginning with specific letters. Of these letters, the most frequently used are F, A and S. It is a sensitive test for assessing frontal lobe functions. OBJECTIVE: To provide normative data for the elderly Brazilian population on the FAS test and to investigate the effects of age and schooling on test performance. METHODS: The individuals were divided into three age groups (60-69, 70-79 and =80 years), and into four groups according to education (1-3, 4-7, 8-11 and 12 years). All subjects were assessed by the Mini Mental State Examination and the FAS. Data were analyzed with Student's t test, ANOVA, simple linear regression and Spearman's correlation. RESULTS: We evaluated 345 cognitively healthy volunteers, 66.66% being female, aged 60 to 93 years, with an educational level ranging from one to 24 years. The average (number of items) ±SD for the whole sample was 28.28±11.53. No significant effect of gender was observed (p=0.5). Performance on the MMSE and education exerted a direct influence on FAS scores (p<0.001), with education being the most significant factor. A positive correlation was found between FAS and the MMSE (r=0.404; p<0.001). CONCLUSION: The performance of Brazilian elderly on the phonemic verbal fluency tests-FAS is significantly influenced by education, where individuals with higher educational level present better performance than those with fewer years of schooling. Age and gender did not prove significant with the FAS.

Testes de fluência verbal fonêmica avaliam a produção de palavras que se iniciam com determinadas letras. Destas, as mais utilizadas são F, A e S. É um teste sensível para avaliar funções do lobo frontal. OBJETIVO: Estabelecer dados normativos para a população idosa brasileira no teste de fluência verbal fonêmica FAS e investigar os efeitos da idade e escolaridade no mesmo teste. MATERIAIS E MÉTODOS: Os sujeitos foram divididos em três grupos de idade (60­69, 70­79 e =80 anos) e quatro de escolaridade (1­3, 4­7, 8­11, ≥12 anos). Todos foram avaliados pelo Mini-Exame do Estado Mental e fluência verbal fonêmica FAS. Os dados foram analisados com o test t de Student, ANOVA, regressão linear simples e correlação de Spearman. RESULTADOS: Foram avaliados 345 idosos cognitivamente saudáveis, 66,66% do gênero feminino, idade entre 60 e 93 anos e escolaridade entre 01 e 24 anos. A média (número de itens) ±DP na amostra toda foi 28.28±11.53. Não houve influência do gênero nos resultados (p=0.5). A performance no MEEM e o nível educacional exerceram influência direta nos escores do FAS (p<0.001), com a educação sendo o fator mais importante. Uma correlação positiva foi encontrada entre os escores no FAS e MEEM (r=0.404; p<0.001). CONCLUSÃO: O desempenho de idosos brasileiros no Teste de Fluência Verbal Fonêmica ­ FAS é significativamente influenciado pelo grau de escolaridade, com os indivíduos com nível educacional mais elevado apresentando desempenho superior àqueles com menos tempo de estudo formal. Idade e gênero não apresentaram significância com o FAS.

Dementia caregiver burgen in a brasilian sample: Association to neuropsychiatric symptoms.

Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce. OBJECTIVE: To investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia. METHODS: The Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson's correlations were calculated to measure the level of association between the scores on both instruments. RESULTS: Among the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients' NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000). CONCLUSION: The presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.

Cuidar de idosos com demência, especialmente se eles apresentam transtornos de comportamento, pode ser extremantente exaustivo para os familiares e cuidadores. Geralmente, ocorrem mudanças no estilo de vida da família, e o cuidador precisa lidar com grande diversidade de problemas. Informações sobre este tema na América Latina, incluindo o Brasil, ainda permanece escasso. OBJETIVO: Investigar a relação entre a presença de sintomas neuropsiquiátricos e o nível de sobrecarga do cuidador em um grupo de idosos brasileiros com demência. MÉTODOS: As versões brasileiras do Inventário de Sobrecarga de Zarit (ISZ) e do Inventário Neuropsiquiátrico (INP) foram administrados a um total de 83 cuidadores-familiares de pacientes com demência acompanhados em um ambulatório universitário. A correlação de Pearson foi calculada para medir o nível de associação entre os escores em ambos os instrumentos. RESULTADOS: Entre os cuidadores, 83,1% eram mulheres, com idade média de 55,6±12,8 anos. Os escores do ISZ variaram entre 3 a 79 (média=31,4). Os escores do INP dos pacientes alcaçaram escores entre 0 a 102 (média=26,9), compatível com elevado grau de manifestações comportamentais na maioria dos pacientes. Uma correlação positiva significativa foi encontrada entre os escores obtidos no ISZ e o INP (r=0,402; p=0,000). CONCLUSÃO: A presença e a gravidade das manifestações comportamentais avaliadas pelo INP estão associadas ao alto nível de sobrecarga do cuidador nesta amostra de idosos brasileiros com demência.

Brazilian caregiver version of the Apathy Scale.

No Brazilian version of a specific scale for evaluating apathy in dementia is available. OBJECTIVES: To introduce a translated version of the Apathy Scale (AS) for use with caregivers. METHODS: The instrument was formally translated and then administered to the caregivers of a small sample of dementia patients, in order to assess scale comprehensibility and make final adjustments. The scale was subsequently administered to the caregivers of a second, independent sample of Alzheimer's disease (AD) patients. The content validity of the scale was tested by correlating the AS scores with the Neuropsychiatric Inventory (NPI) - apathy sub-score and Disability Assessment in Dementia (DAD) total scores. RESULTS: The first sample consisted of eleven subjects with dementia, most of whom had AD. The second sample comprised twenty patients with probable or possible AD (10 with mild dementia), a mean age of 84.1±5.8 years, and 2.2±1.6 years of schooling. The AS scores correlated with both NPI-apathy sub-score (r=0.756, p=0.001) and DAD total scores (r=-0.793, p=0.0005). CONCLUSIONS: The final version had good comprehensibility and correlated strongly with standardized apathy and functional activities of daily living measures.

Não há versão brasileira de qualquer escala especificamente dedicada à avaliação de apatia nas demências. OBJETIVOS: Apresentar uma versão traduzida da Escala de Apatia direcionada ao cuidador. MÉTODOS: O instrumento foi formalmente traduzido e administrado aos cuidadores de uma pequena amostra de pacientes com demência, para avaliar a compreensibilidade da versão e realizar ajustes finais. Em seguida a escala foi administrada aos cuidadores de uma segunda amostra independente de pacientes com doença de Alzheimer (DA). A validade de conteúdo da escala foi testada correlacionando-se os escores da Escala de Apatia com os subescores de apatia do Inventário Neuropsiquiátrico (NPI) e com os escores totais da escala DAD de incapacidade na demência. RESULTADOS: A primeira amostra consistia de onze pacientes com demência, a maioria com doença de Alzheimer (DA). A segunda amostra possuía vinte pacientes com DA provável ou possível (10 com demência leve), média de idade de 84,1±5,8 anos e escolaridade média de 2,2±1,6 anos. Os escores na Escala de Apatia correlacionaram-se com o subescore apatia do NPI (r=0,756; p=0,001) e com os escores totais da DAD (r=­0,793; p=0,0005). CONCLUSÕES: A versão final apresentou boa compreensibilidade e correlacionou-se fortemente com medidas padronizadas de apatia e atividades de vida diária.